Dietary supplements: are they he althy, what is their effect and what is our knowledge about them? What dietary supplements do Poles take and how often, what are their opinions about them? The portal nazwanikzdrowie.pl was looking for answers to these questions together with the monthly "Zdrowie". What did the report we prepared reveal?

According to the definition, "a dietary supplement is a food the purpose of which is to supplement a normal diet, which is a concentrated source of vitamins or minerals or other substances with a nutritional or other physiological effect." The vitamins and minerals used in the production of drugs and dietary supplements most often come from the same producers. Prof. Iwona Wawer, head of the Department of Physical Chemistry of the Medical University of Warsaw, explains:

- Even if they are produced outside the EU (e.g. vitamin C in China), they must meet high requirements as to the production method (GMP), quality, microbiological purity, etc. Therefore, it is worth buying products of good companies with research facilities -scientific.

Medicines and supplements differ in legal regulations - drugs are supervised by the Pharmaceutical Inspection, dietary supplements by the Sanitary Inspection, because they are food products. Medicines contain therapeutic doses, supplements contain physiological doses, usually lower.

- The exclusion of supplements from pharmacies is a he alth risk - emphasizes prof. Iwona Wawer. - Why? As patients will lose a reliable, competent source of information about these products, the opportunity to obtain advice. Trade will move to the Internet, where these products are difficult to control.

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Dietary supplement and drug

The regulations of different countries refer to dietary supplements differently, considering them to be food or drugs. However, the Codex Alimentarius set of international nutritional standards recognizes dietary supplements containing vitamins and trace elements as food. In Poland, they are considered foodstuffs, and this is regulated by the Food and Nutrition Safety Act of August 25, 2006. It states, inter alia, that vitamins, minerals and other substances with a nutritional or other physiological effect may be added to foodstuffs. Separate regulations define what substances and in what amounts can be added to food, and each package of the supplement must containinformation on storage and dosage. Labels or leaflets must not contain content (so-called medical statements) suggesting that a given product or its ingredient prevents or treats specific diseases. In Poland, dietary supplements are authorized by the Chief Sanitary Inspector, not the Chief Pharmaceutical Inspector or the Office for Registration of Medicines and Biocidal Products.

Dietary supplements: do we need them?

Is taking dietary supplements necessary, explains Agnieszka Jarosz, MD, PhD, Head of the Center for Promotion of He althy Nutrition and Physical Activity at the Food and Nutrition Institute:

- A properly balanced diet provides all the nutrients necessary for the proper functioning and development of the body.

Dietary supplements should also be used in various types of elimination diets, very low in energy.

Unfortunately, due to the pace of life, we spend less and less time and attention on preparing meals, which makes them poor in terms of quality. Therefore, the demand for dietary supplements and fortified foods is increasing. He alth conditions should be the reason for using dietary supplements. These include disease states, e.g. atherosclerosis, osteoporosis, and neoplastic diseases. Supplementation is needed by people exposed to nutrient deficiencies, e.g. menstruating heavily or pregnant. High magnesium deficiency may occur in people with malabsorption syndrome, chronic diarrhea, alcohol abuse, the use of drugs (some antibiotics and immunosuppressants, diuretics), as well as in diabetes, thyroid, kidney, pancreatic and heart diseases. It is also known that vitamin D deficiency is common in our society. It is influenced by the geographical zone and staying in closed rooms for many hours. We also use cosmetics that protect against UV rays, but also hinder the synthesis of vitamin D in the skin. This process also does not work properly in the elderly. Therefore, wise supplementation is necessary. Children should get 600 units of vitamin D per day and adults - 800 units.

Mineral deficiencies and cancer

The discovery of recent years is the statement that deficiencies of certain vitamins and minerals may contribute to an increased risk of cancer.

- Of particular importance is selenium, which Poles certainly lack - claims prof. Jan Lubiński, head of the Department of Genetics and Pathomorphology of the Medical University of Warsaw. - Its average concentration in our food products is twice lower than, for example, in the StatesUnited, which is related to the quality of Polish soil. The optimal concentration of selenium in the blood serum should be 75-85 μg / l for women, 85-120 μg / l for men, and Poles have an average of 70 μg / l.

Research shows that people with too low or too high selenium levels are more likely to develop cancer. This regularity applies to cancer of the lung, colon, pancreas, stomach, breast and prostate. In order to obtain the optimal concentration of selenium, our diet should be enriched with 25-50 μg of the element daily, either in the form of a varied diet or in the form of selenite preparations. However, the level of the element in the blood should be checked beforehand. Selenium inhibits the multiplication of cancer cells. It has a beneficial effect on the thyroid gland. After the selenium level has been equalized, for example, psoriatic lesions regress. In women with hashimoto's, the administration of selenium often eliminates the problem, because the element regulates the synthesis of hormones produced by the thyroid gland. Another advantage of the element is its good influence on the maturation of sperm - 10 percent of male sterility is the result of selenium deficiency. Prof. Jacek Szaflik from the Independent Public Clinical Ophthalmology Hospital in Warsaw adds:

- The right concentration of selenium also protects against cataracts. At a low level, the risk of cataracts in women is 5 times higher than in people with normal levels of the element, and in men - 8 times higher.

Worth knowing

The reason why we reach for dietary supplements should be he alth conditions, i.e. disease (e.g. atherosclerosis, osteoporosis, cancer, chemotherapy impeding proper nutrition), elimination diets, e.g. due to food allergies or very low diets energetic. Supplements are also recommended for people exposed to nutrient deficiencies, e.g. young, abundantly menstruating women. A he althy and properly nourished person usually does not need dietary supplements. Anyone who takes the supplement should read the leaflet or label carefully, especially the information on the content of nutrients (vitamins, minerals), recommended daily dose and warning about the possibility and effects of overdosing.

Dangerous effects of an overdose of dietary supplements

The decision on supplementation should be made on the basis of research confirming whether there are deficiencies in specific ingredients in the body and whether increasing their daily dose is needed for therapeutic purposes - says Agnieszka Jarosz. - How does it work with beta-carotene and retinol (vitamin A)? Eating vegetables and fruits rich in carotenoids has been shown to reduce the risk of lung cancer, while beta-carotene supplementation does not.action and even increases the risk of this cancer in smokers. Excessive consumption of choline (vitamin B4) can cause a drop in blood pressure, sweating, nausea and diarrhea. The excess of vitamin D may be manifested by an increased "escape" of calcium and phosphorus from the bones, cardiac arrhythmias or calcium deposition in soft tissues. Undesirable effects of excessive calcium intake include kidney disease, damage to the structure of many organs, and malabsorption of other ingredients, such as iron, magnesium and zinc. Excessive consumption of synthetic folic acid can mask the symptoms of vitamin B12 deficiency, which makes diagnosis difficult and prevents the prevention of irreversible degenerative processes in the nervous system. Moreover, excess folic acid in early neoplastic lesions may accelerate their development. Too much iron supply leads to an increase in free radicals and, consequently, to an increased risk of cancer and ischemic heart disease. Many more examples can be given.

Dietary supplements and vitamins and minerals in food

Therefore, dietary supplements can supplement the deficiency of specific substances, if it is confirmed by research. But it's also worth knowing that vitamins and minerals are also added to food.

- Food enrichment consists in adding one or more ingredients to a product, regardless of whether they are normally present in the product or not, explains Prof. Małgorzata Kozłowska-Wojciechowska, head of the Department of Pharmaceutical Care of the Medical University of Warsaw. - The aim is to prevent deficiencies and supplement specific vitamins and minerals in whole populations or selected population groups. Some products are fortified on a mandatory basis, others on a voluntary basis. Producers of voluntarily fortified foods are required to include this information on the packaging, and they must add a significant amount of the substance to the product.

But sometimes it is done with no moderation. Barbara Ratkovska, a food labeling expert, after analyzing 100 products, found that some products, such as grain products, contain 50 percent more vitamins and minerals than the recommended daily allowance, and lower-fat margarines - as much as 250 percent.

Although we often do not know it, ordinary food products, e.g. flour, juices, mineral water, s alt, candies are also enriched with vitamins and minerals.

Vitamins and minerals cannot only be added to unprocessed foods (fruits, vegetables, meat, poultry, fish) and to beverages containing more than 1.2 percent alcohol by volume. In Poland, it is obligatory to add vitamin A and vitamin D tospreads. This is true of all margarines and low-fat butter. There is also a requirement to enrich the s alt with potassium iodide or iodate. The group of products that are voluntarily enriched with vitamins and minerals is very long. Voluntarily oils and margarines can be enriched with vitamin E, and margarines themselves with some minerals. Vitamins C, B, E, A and calcium are added to juices and soft drinks. Grain preparations (including flour) may contain B vitamins, folic acid, calcium and iron. Milk and milk products also contain vitamin A and calcium, but also vitamin D. Confectionery products are enriched with B vitamins, folic acid, calcium and iron. Magnesium is added to soluble cocoa, pudding or instant coffee. By reaching for such products and supplementing them at the same time, we can overdose some vitamins and minerals.

What dietary supplements does the Pole choose and why?

As the report showed, the reason why we most often take dietary supplements is to strengthen the body (77 percent of respondents). More than half of the respondents want to avoid infection or say they lack energy; a significant group mentions the need to reduce stress and the desire to improve one's beauty as a motive. Of those who don't take supplements, 26 percent don't trust them. Most of the respondents assessed the effects of the supplements positively - 26 percent thought they felt significantly better, 50 percent saw improvement, but the expectations were higher. The most numerous group (81 percent) consumes magnesium. Vitamin C is second (76 percent), followed by vitamin D (58 percent). This is followed by calcium (58 percent), folic acid (36), selenium (26), and probiotic bacteria (24 percent). The respondents claim that the supplements are most often purchased in stationary pharmacies, after consulting a pharmacist. They also take the doctor's opinion into account. But - interestingly - as many as 73 percent do not consult him on taking supplements.

Four experts sat on the Scientific Council of the Report:

Agnieszka Jarosz, MD, PhD, head of the Center for Promotion of He althy Nutrition and Physical Activity at the Institute of Food and Nutrition

prof. Małgorzata Kozłowska-Wojciechowska, gastroenterologist, head of the Department of Pharmaceutical Care of the Medical University of Warsaw

prof. Jan Lubiński, geneticist and oncologist, head of the Department of Genetics and Pathomorphology PUM

dr hab. chem., prof. ordinary n. farm. Iwona Wawer, head of the Department of Physical Chemistry of the Medical University of Warsaw

You can read the details of the report on dietary supplements prepared by the Pollster Research Institute in the article belowlink.

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